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About Tricia
Expertise
Has your medical insurance company denied your claim and refuses to pay? Have
you received a pre-authorization and still your insurance company
refuses to pay? How can you get your insurance company to reverse a
denied claim? How do you get a provider to waive your copayment if you
are financially unable to pay? Can a provider sue you for a unpaid bill and
will they? Can a provider send me to a collection agency for a medical bill?
If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay.
I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!
Experience
In the medical field for over 20 years spending majority of time in the collections aspect.
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You are here: Experts > Health/Fitness > Health Care: UK > Medicare, Medicaid, Insurance, HMO problems > Insurance granted then denied
Expert: Tricia - 10/22/2009
Question
QUESTION: Hello - I read a similar question and answer from you, but need you to clarify in this case please. My husband was admitted to hospital (pneumonia) in Europe, and they would not have admitted him had the insurance not been granted. It was. Many emails and phonecalls to this effect. Even when he was discharged, I asked once again if all was okay with the insurers. Some time later, we were contacted by the insurers who had found a loophole in the contract and were now denying payment to the hospital. The hospital is now claiming it from us.
Who is liable? We could not have had the treatment had the insurance not been approved.
We were so disgusted with the medical insurance company after so many years of paying and not claiming, that we since stopped our coverage with them. However, they just dropped the hospital, who is now wanting to get bill collectors onto us. Your advice would be greatly appreciated. Thank you.
ANSWER: Hi Penelope!
You probably should have not dropped your insurance carrier until after your appeals trying to get them to pay. They have no incentive to work with you when you are no longer a subscriber.
The only thing you can do now is to appeal their denial. Unsure what the denial was but you need to prove it wrong and that it was medically necessary for your husband to be admitted to the hospital. Back up your appeal with Dr's letters supporting this. The more information you send in an appeal the better chance for the insurance company to overturn a denial.
If you did get a pre-authorization or pre-approval then fight the insurance company with this information during your appeal. If you only received a verbal okay, then try to submit names and dates of whom you spoke to.
Insurance companies will find any way not to pay bills so you have to find ways for them to.
Look at your denials to see where to send your appeal, your time limit to do so and the procedure. Every insurance company is different so you must follow their appeal guidelines.
If you get bills from a collection agency at this point I would advise them that you are appealing their denial and ask for 60 days to do so.
Good Luck!
Tricia
---------- FOLLOW-UP ----------
QUESTION: Thank you so much for your most informative reply. The authorisation was later denied because we had been ''out of the area'' for longer than 3 months. Small print we had never noticed nor were told about - we are big travelers, mostly on the move. I went back to the appeal rules, and we are over the time limit. So it looks like we are unfortunately the losers here. How many options do you think I have? 1) Hide! 2) Pay
If the latter, it would be difficult to come up with the total immediately, which is what the hospital is asking for (15 days). If the former - do these hospital and their future collection agencies eventually 'get their man'?
Answer
I am not sure about hospitals in Europe as far as how hard they will try to collect. I know that hospitals in the US can actually garnish federal and state refund taxes in some states and also put a negative mark on your credit report.
Will this hospital go away? Unsure......you can always negotiate the bill with them.....they would rather take something now then perhaps nothing later. You can start with 50% and see if they will bite.....they may since they know that being out of Europe it would be harder for them to collect.
Collection agencies can be brutal. If they get one in the states then they will pursue hard.
Good Luck!
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